NORCET 8 Prelims-2025: Lumbar puncture is contraindicated in which of the following conditions?

NORCET 8 Prelims-2025

Medical & Surgical Nursing

Easy

Appeared in: NORCET 8 Prelims-2025

Explanation

A lumbar puncture is absolutely contraindicated in patients with suspected or confirmed high intracranial pressure (ICP).
The procedure involves removing cerebrospinal fluid (CSF), which can create a pressure gradient between the cranial and spinal compartments.
This pressure difference can lead to a life-threatening downward displacement of the brain, known as cerebral or tonsillar herniation (coning).
Before performing an LP in a patient with suspected high ICP (e.g., showing papilledema, focal deficits, or depressed consciousness), a CT or MRI scan is necessary to rule out a mass effect.

Option A: Headache is a common reason to perform a lumbar puncture, not a reason to avoid it. It is a primary symptom of conditions like meningitis and subarachnoid hemorrhage, which are diagnosed via LP.
Option C: General back pain is not a contraindication. The procedure may be more challenging, but it is not forbidden.
Option D: Mild fever is a classic sign of infection, and a lumbar puncture is a key diagnostic tool to investigate for central nervous system infections like meningitis.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Contraindications for Lumbar Puncture as background academic context rather than a clinical decision trigger.
A nurse's primary role before an LP is to perform a thorough neurological assessment to check for signs of increased ICP, such as changes in level of consciousness, pupillary changes, new focal deficits, or the Cushing's triad (hypertension, bradycardia, irregular respirations).
Any signs suggestive of increased ICP must be immediately reported to the physician, as proceeding with the LP could be fatal.
Patient positioning (lateral recumbent or sitting upright) and ensuring patient stillness are critical nursing responsibilities during the procedure to ensure safety and success.

How to Approach the Question

First, identify the core of the question: it asks for a contraindication, meaning a reason not to perform a lumbar puncture (LP).
Next, consider the mechanics of an LP: a needle is inserted into the spinal canal, and cerebrospinal fluid (CSF) is removed.
Evaluate each option. Think about whether the condition would be made worse by removing CSF.
For 'Increased ICP', recall that the skull is a fixed box. Removing fluid from the connected spinal space when pressure is already high in the skull can cause a dangerous pressure shift.
For 'Headache', 'Back pain', and 'Mild fever', consider if these are reasons to investigate the CSF. Headache and fever are classic signs of meningitis, a primary reason to perform an LP. Back pain is generally unrelated unless it's at the specific puncture site.
Conclude that increased ICP is the only condition listed where the procedure itself poses a direct, life-threatening risk (herniation), making it a clear contraindication.

Concept Tested & Keywords

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E6 Medicine Davidson Principles Practice 24e p. 1097-1099

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 pp. 919-921, 1568-1570